What is the daily dosage of tadalafil (Cialis) for erectile dysfunction?

Tadalafil Dosage for Erectile Dysfunction

The recommended daily dosage of tadalafil for erectile dysfunction is 2.5 mg initially, which may be increased to 5 mg based on individual efficacy and tolerability, taken at approximately the same time every day regardless of timing of sexual activity. 1

Dosing Options

• Once-daily dosing:

  • Starting dose: 2.5 mg taken at approximately the same time every day 1
  • May be increased to 5 mg based on individual response and tolerability 1
  • Taken without regard to timing of sexual activity 1
  • Can be taken without regard to food 1

• As-needed dosing (alternative option):

  • Starting dose: 10 mg taken prior to anticipated sexual activity 1
  • May be adjusted to 5-20 mg based on efficacy and tolerability 1
  • Maximum recommended frequency is once per day 1

Efficacy of Daily Dosing

• Daily tadalafil (2.5-5 mg) significantly improves erectile function compared to placebo, with improvements in:

  • International Index of Erectile Function (IIEF) scores 2
  • Successful intercourse completion rates of 50-62% versus 33% for placebo 3
  • Return to normal erectile function (IIEF-EF ≥26) in approximately 40% of men who had incomplete response to as-needed PDE5 inhibitors 4

• Unlike sildenafil and vardenafil, tadalafil's efficacy is not dose-dependent between 5-20 mg, making lower daily doses an effective option 5

Advantages of Daily Dosing

• Eliminates need to time medication with sexual activity, allowing for more spontaneous sexual encounters 6
• Provides continuous therapeutic plasma levels due to tadalafil's long half-life (17.5 hours) 2
• May be particularly beneficial for couples who prefer spontaneous rather than scheduled sexual activity 6
• Studies show comparable efficacy between daily dosing and on-demand regimens 7

Special Considerations

• Renal impairment:

  • For creatinine clearance 30-50 mL/min: Start with 2.5 mg, may increase to 5 mg based on response 1
  • For creatinine clearance <30 mL/min or on hemodialysis: Daily dosing not recommended 1

• Hepatic impairment:

  • Mild to moderate impairment (Child-Pugh Class A or B): Use with caution 1
  • Severe impairment (Child-Pugh Class C): Not recommended 1

• Common adverse effects:

  • Most frequent: dyspepsia, headache, back pain, nasal congestion, and myalgia 6, 3
  • Generally mild and well-tolerated with daily dosing 2, 8

Important Clinical Considerations

• Incorrect use accounts for many treatment failures; ensure patients understand that:

  • Sexual stimulation is still necessary for the medication to be effective 6
  • Tablets should not be split; entire dose should be taken 1
  • Daily dosing requires consistent daily administration 1

• Men with diabetes or post-prostatectomy may have more severe ED at baseline and may respond less robustly to PDE5 inhibitors 5

• Tadalafil is contraindicated in patients taking nitrates due to risk of significant hypotension 6